NOTE: THIS FORM IS ABSOLUTELY NECESSARY. IF YOU HAD ANY FINANCIAL ACTIVITY, WE NEED THIS FORM COMPLETED AND A FINANCIAL BALANCE SHEET. IF YOU HAD NO CURRENT OR PAST FINANCIAL ACTIVITY, WE NEED A PROJECTED BUDGET. (JUST USE THE FORM BELOW TO GIVE US AN IDEA OF WHAT THE BUDGET WILL BE - YOU CAN USE THE MINIMUM OR MAXIMUM EXPENSE OR INCOME FIGURES - IT IS UP TO YOU AND IT IS ONLY A PROJECTED BUDGET.

Please be as Complete as Possible: this information is required. You may substitute your own receipts and expenses statement, or statements, but the details must

be complete as indicated in this statement. Failure to provide complete financial information may result in denial of the exemption application.

•

For each year exempt status is requested, provide the financial information represented in the statement below.

• If you have had financial activities for less than one year, provide a financial statement for the period of activities, and a projected budget for the entire first year.

•

If this is your first year of operation, and/or you have no prior financial activity, provide a proposed budget for the entire first year of operation. The proposed budget should be based on your most reasonable expectations. . . . . . . . . . . . . . .

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FTB 3500 Exemption Application PART TWO

Corp Name

Receipts

Current Year

Three Preceding Years for each Year in Existence

Example (2000 , 2001, 2002,)

Totals

Grants

Contributions received

Fundraising

Membership income

Nonmembership income (R&TC Section 23701g)

Other business income

Gross investment income

Gross royalty income

Gross rental income

Gross receipts from admissions

Gross receipts from commissions

Gross receipts from sale of merchandise .

Gross receipts from services provided

Gross receipts from furnishing of facilities

Gain or loss from sale of capital assets

Other income (attach sheet itemizing each type)

TOTAL RECEIPTS

EXPENSES

Fundraising

Contributions, gifts, grants, and similar amounts paid

Disbursements to or for member benefit

Compensation of officers

Compensation of directors

Compensation of trustees

Rental income

Other salaries and wages

Occupancy (rents)

Other (including all operational and administrative

expenses – attach sheet) .

TOTAL EXPENSES

Excess of receipts over expenses

In order to avoid losing your info, If you have problems submitting your form, ( for example you get a message: "oops! must be a tripod website" ) after you receive the oops message, just click the "back" button and complete the missing information - if you still receive an oops message, you may want to just print the completed form and mail it to:

xkr essex, inc 2911 e. vista st. #C long beach, ca 90803

Note:
After you submit this form, You will be Re -
directed to a Confirmation Page